Hysteropexy. A review
Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA.Minerva ginecologica 01/2009; 60(6):509-28.
Uterine prolapse is a common problem in women that negatively affects one's quality of life. Surgical treatment commonly involves a hysterectomy followed by vaginal vault suspension of some type. Hysteropexy to treat uterovaginal prolapse has a long history dating back to the 1800s and has gone through many changes. Recent literature describes vaginal, open abdominal and laparoscopic approaches. Vaginal sacrospinous hysteropexy is well-supported by the scientific literature. Favorable postoperative outcomes range from 62-100% and additional data show improved quality of life and sexual function. Anatomic outcomes appear to be comparable to vaginal hysterectomy with sacrospinous ligament vault suspension. Additionally, encouraging outcomes following pregnancy have been described. The sacrohysteropexy, performed through a laparotomy incision or laparoscopically, also has favorable data, with cure rates ranging from 91-100%. Studies supporting this procedure also describe improvements in quality of life and sexual function. Complications related to these procedures are similar to those described after vaginal vault suspension using comparable techniques, although most studies report shorter operative times and less blood loss. At the present time, hysteropexy, either transvaginal or abdominal, seems to be a safe procedure with acceptable results in women who desire uterine preservation. As these procedures gain popularity and data become available, questions related to patient selection, surgical durability, outcomes following pregnancy, and complications related to risk of uterine pathology will likely be answered.
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ABSTRACT: Attitudes to sexuality and the psychological value of reproductive organs have changed in Western countries over the last few decades. Nevertheless, repair of pelvic support defects with concomitant hysterectomy is still considered the standard treatment for pelvic organ prolapse. Over the last 10 years, however, interest has been growing in uterus-sparing surgery, which can be divided into vaginal, abdominal, and laparoscopic procedures. The majority of studies on uterus-sparing surgery, with the exception of abdominal techniques, report few cases with short follow-up. Sacrospinous hysteropexy is the most studied vaginal technique for uterus preservation and favorable results have been demonstrated, although the majority of studies are flawed by selection and information bias, short follow-up and lack of adequate control groups. Abdominal and laparoscopic procedures are promising, providing similar functional and anatomical results to hysterectomy and sacrocolpopexy. Consensus is growing that the uterus can be preserved at the time of pelvic reconstructive surgery in appropriately selected women who desire it. The results of comparison trials and prospective studies confirm that uterus-sparing surgery is feasible and is associated with similar outcomes to hysterectomy, as well as shorter operating times. Surgeons should be ready to respond to the wishes of female patients who want to preserve vaginal function and the uterus.Nature Reviews Urology 11/2010; 7(11):626-33. DOI:10.1038/nrurol.2010.164 · 4.84 Impact Factor
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ABSTRACT: Total Prolift(®) is a pelvic floor repair system that is performed transvaginally and can be carried out with or without the uterus in situ. To compare surgical outcomes following total Prolift colpopexy (TPC) and total Prolift hysteropexy (TPH). This was a retrospective cohort study of women that underwent TPC (n = 65) or TPH (n = 24). Outcomes were compared between groups using Student's t-test, ANCOVA and Fisher's exact tests (P ≤ 0.05). There were no significant differences between TPC and TPH for all peri-operative variables. Patients were followed 6-12 months after surgery. Post-operatively, TPC patients had significantly higher pelvic organ prolapse-quantification (POP-Q) point C measurements (P = 0.05); however, all other POP-Q measurements were similar, including POP-Q apical stage of prolapse, with 99% in the TPC group and 92% in the TPH group at stage I or less. Post-operative mesh erosion, prolapse symptoms, surgical satisfaction, sexual activity and dyspareunia rates did not significantly differ between groups. This study showed that TPC and TPH have similar surgical outcomes, except for vaginal vault measurements reflected by POP-Q point C.Australian and New Zealand Journal of Obstetrics and Gynaecology 02/2011; 51(1):61-6. DOI:10.1111/j.1479-828X.2010.01258.x · 1.51 Impact Factor
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ABSTRACT: Uterine prolapse is one of the common reasons for hysterectomy throughout the world. However, recent data has shown that uterine-sparing techniques appear to be equivocal to that of hysterectomy. Older reports of intra-abdominal uterine suspension describe open approaches and more recent descriptions involve robotic and laparoscopic approaches utilizing mesh. We describe the first reported laparoendoscopic single-site (LESS) sacral hysteropexy utilizing a strip of polypropylene mesh placed posteriorly on the uterus and attached to the sacral promontory. A 45-year-old female with grade 3 uterine prolapse, cystocele, and rectocele underwent the procedure. The procedure involved access utilizing a single-port system placed transumbilically, and dissection using articulating laparoscopic instruments. The hysteropexy was completed by placing a 3-cm wide strip of polypropylene mesh along the posterior vaginal wall and cervicouterine junction, and suturing the proximal end to the anterior longitudinal ligament overlying the sacral promontory. The patient was discharged home within 18 h of the procedure. At 6 month follow-up, the patient has excellent anatomic support, with no evidence for recurrence of prolapse. LESS hysteropexy appears to be a safe, effective procedure for uterine prolapse and provides patients with excellent outcome with no visible scar. Additional studies will determine whether the LESS approach provides any benefit when compared with robotic or traditional laparoscopic approaches with respect to blood loss, pain, and time of full recovery.09/2011; 64(1):53-7. DOI:10.1007/s13304-011-0107-2
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